Twenty seven percent of adults in the U.S. have a disability. Involving people with disabilities in everyday activities and ensuring they have roles similar to others who do not have a disability is known as disability inclusion. Disability inclusion is essential as it allows people with disabilities to have equal access to opportunities at school and work, and to participate in recreational and community activities. Disability inclusion benefits everyone as it promotes a stronger more diverse culture minimizing abuse, violence, and neglect. Disability inclusion can also improve the health of people with disabilities as those with disabilities are more likely than those without a disability to smoke and have diabetes, heart disease, and obesity. Local health department’s (LHDs) health promotion programs and activities, thus, must consider best practices for how to promote disability inclusion in all aspects of healthy living programs. This blog addresses key terms related to disability inclusion as well as physical, communicative, and programmatic accessibility considerations for all phases of health promotion programming conducted by LHDs.
Key Terms Related to Disability Inclusion
There are several terms that need to be addressed to better understand disability inclusion. These include equality versus equity, cultural competence, and linguistic competence. Equality means everyone is provided the same resources or opportunities. In contrast, equity is providing varying levels of support and assistance depending on individualized needs, abilities, or circumstances. For example, if a LHD is promoting a physical activity program promoting biking, the types of bikes need to be considered. Using this example, equality would mean that everyone has access to a bike. Equity, however, would take into consideration the type of bike, size of the bike, modifications, or other types of wheelchair or mobility aides that one can use instead of a bike to participate in the same activity.
Cultural competence requires organizations have a designated set of values and demonstrate behaviors, attitudes, structures, and policies that value diversity, conduct self-assessment, manage differences, embed cultural knowledge, and adapt diversity and the cultural contexts of the communities they serve. People with disabilities experience numerous health disparities, including poorer self-rated health, higher rates of obesity, smoking, and inactivity, and fewer cancer screenings. Cultural competence can help reduce these health disparities. Initially, cultural competence focused primarily on racial and ethnic differences, but more recently, the definition has been expanded to include marginalized populations such as those with disabilities.
Linguistic competence is the ability of an organization to communicate necessary information in a manner that is easily understood by a diverse group of people, including those that have a hearing impairment, persons with limited English proficiency, those that have low literacy or are illiterate, and persons with disabilities. Cultural and linguistic competence are major priorities included in Healthy People 2030’s national initiatives. Increasing both cultural and linguistic competence in public health programs may decreasing health disparities for people with disabilities.
Disability Inclusion for LHD Staff
When planning and implementing health promotion programs that include people with disabilities, LHDs should first consider how their own organization provides training, accessibility, and policies and procedures for its employees. For example, are reasonable accommodations provided, and are they individualized to the person with the disability? For a more detailed look at LHD disability inclusion practices within organizations themselves, please see Local Health Department Action Steps for Disability Inclusion - NACCHO.
Physical Accessibility Considerations for LHD Health Promotion Programs
- Parking: Make sure that adequate parking is available, specifically with spaces designated as handicapped accessible close to entrances. Parking spaces should include an 8-feet-wide access aisle.
- Ramps and Curb Cuts: There should be easy access into and out of a facility. Ramps (fixed or portable) should be available and curb cuts should be smooth to allow ease of use for various mobility assistive devices.
- Space: When evaluating various potential spaces to use for health promotion programs, LHDs should not only consider physical accessibility, but also usability. For example, while many physical activity facilities may offer ramps, at least one accessible bathroom, and space around some exercise machines per the Americans with Disabilities Act (ADA) guidelines, usability concerns include lack of universal equipment, proper signage, removal of physical obstructions, and accessible routes between equipment. Furthermore, ensuring appropriate lighting will aid in participation in program activities.
- Transportation: Some barriers preventing access to transportation include: 1) living in a rural area; 2) cost; 3) limited or a lack of transportation options; and 4) the inability to obtain a driver’s license. LHDs may wish to consider health promotion program sites that are accessible to bus routes, are of low cost, and are available in rural settings. Toolkits are available to assist LHDs in planning for participants’ transportation concerns.
Communicative Accessibility Considerations for LHD Health Promotion Programs
- Communication Formats: When designing informational handouts advertising health promotion programs or materials as part of a health promotion program, different communication formats should be provided such as large print, Braille, and screen readers. Furthermore, speak directly to participants and not their caregivers, companions, or interpreters.
- Website Accessibility: Strive for website accessibility. Some ways to promote website accessibility include having sharp color contrasts between background colors and font colors, describing what is shown in images, and providing the option to view text within different font sizes. Closed captioning should also be provided for web-based educational sessions or other forms of digital media for those with a hearing impairment. Writing in plain language using simple sentences may also increase readability and understanding of material provided.
Programmatic Accessibility Considerations for LHD Health Promotion Programs
- Expenses: It is important for LHDs to calculate the costs of accommodations and accessibility considerations in advance as part of budgeting expenses for health promotion programs, as there may be additional costs associated with producing Braille documents or the hiring of an interpreter, as well as for travel, the workspace itself, equipment, and the hiring of additional staff.
- Perspectives of People with Disabilities: When designing health promotion programs, reach out to local Centers for Independent Living (CILs) for resources, guidance, and other tips to make your program more accessible and beneficial for people with disabilities. Contact key stakeholders and don’t be afraid to ask questions. The more you learn, the better your health program can best meet the needs of all participants involved.
Disability inclusion within LHD programs promotes an equitable experience for everyone. LHDs may wish to consider the physical, communicative, and programmatic accessibility considerations discussed in this blog to promote cultural and linguistic competence. Disability inclusion starts with understanding key terms and manifests into programs that are accessible, usable, and integrated within the LHD itself and the programs it provides.